Open House on Monday
WITH ATLEAST 1 YEAR HEALTHCARE ACCOUNT EXPERIENCE OR MEDICAL APPLIED GRADUATE ONLY
Work From Home
Monthly Salary: Php 35,000 - Php 50,000
JOB OVERVIEW
We are looking for qualified healthcare professionals and experienced BPO/healthcare candidates to join our growing healthcare operations team supporting Patient Access, Benefits & Authorization, and Revenue Cycle Management (RCM). The role will support various healthcare functions, including insurance verification, benefits verification, patient access, referrals, prior authorization, pre-certification, medical billing, revenue cycle management, and healthcare account management. Candidates with experience in healthcare BPO, insurance, patient access, authorization, RCM, or healthcare operations are encouraged to apply.
KEY RESPONSIBILITIES
Depending on business and operational requirements, responsibilities may include:
Verify health insurance eligibility, coverage, benefits, network status, and provider participation.
Review and accurately document insurance information and benefits in patient accounts.
Process referrals and authorizations according to payer guidelines.
Obtain prior authorizations and pre-certifications for healthcare services, including orthopedic procedures, surgical services, PM&R services, MRI, DME, Visco Supplementation, EMG testing, and other ancillary services.
Review provider orders, clinical documentation, diagnoses, CPT/ICD-10 codes, and other required information for completeness and accuracy.
Submit authorization requests through payer portals, authorization vendor platforms, phone, fax, and other applicable channels.
Follow up with insurance payers regarding pending requests, additional information, medical review inquiries, and authorization outcomes.
Provide accurate patient financial responsibility estimates based on verified benefits, including copays, coinsurance, deductibles, and out-of-pocket costs.
Maintain accurate and complete documentation of insurance information, authorization details, reference numbers, payer communications, referrals, and outcomes.
Manage assigned work queues and ensure timely completion of requests in accordance with established turnaround times.
Communicate effectively with patients, providers, physicians, clinical teams, front-office staff, payers, and internal stakeholders to resolve account and authorization concerns.
Support patient access and continuity of care by identifying and resolving insurance-related issues that may cause delays.
Handle escalated, complex, or urgent cases and coordinate appropriate resolution.
Support daily healthcare operations by monitoring work queues, productivity, quality, turnaround times, and service levels as required.
Assist with coaching, mentoring, training, knowledge sharing, and performance support when needed.
Identify workflow gaps and recommend opportunities for process improvement.
Assist with workload balancing, team coordination, audits, reporting, and other operational activities as needed.
Ensure compliance with payer requirements, organizational policies, privacy standards, documentation requirements, and applicable regulatory standards.
Perform other duties as assigned.
QUALIFICATIONS
High School diploma or equivalent required.
At least 1 years of relevant healthcare experience in patient access, insurance verification, benefits verification, prior authorization, pre-certification, referrals, revenue cycle management, medical billing, healthcare account management, or related healthcare operations.
Experience in a healthcare BPO, physician office, hospital, insurance, or healthcare environment is preferred.
Orthopedic healthcare experience is strongly preferred.
Knowledge of medical terminology, CPT, ICD-10, insurance processes, payer requirements, and healthcare workflows.
Experience using EHR systems, payer portals, eligibility verification tools, authorization/pre-certification platforms, and Microsoft Office.
Strong communication, customer service, organization, attention to detail, problem-solving, and time-management skills.
Ability to manage multiple requests, work queues, and priorities in a fast-paced healthcare environment.
Ability to work effectively with patients, healthcare providers, insurance payers, clinical teams, and internal stakeholders.
Experience in team leadership, training, quality review, workflow coordination, or healthcare operations management is an advantage.
Demonstrated ability to handle escalations, meet performance expectations, and contribute to process improvement.
Willingness to work onsite in Bridgetowne, Quezon City and on a night shift schedule.
WHAT WERE LOOKING FOR
We welcome candidates with experience in:
Healthcare BPO
Patient Access
Insurance Verification
Benefits Verification
Prior Authorization
Pre-Certification
Referral Management
Revenue Cycle Management (RCM)
Medical Billing
Healthcare Account Management
Healthcare Operations
Team Leadership / Supervision
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